Under the Millennium Development Goals (MDGs), United Nations Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalised ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States' borders. The Sustainable Development Goals (SDGs) aim to be applied to all, nationals and non-nationals alike. Global migration and its diffuse impact has intensified due to escalating conflicts and the growing violence in many countries. This massive migration and the thousands of refugees crossing borders in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the sidelining of non-nationals in reporting frameworks. The authors have identified four ways to promote the protection of vulnerable non-nationals' health and well-being in States' application of the post-2015 SDG framework: In setting their own post-2015 indicators states should explicitly identify vulnerable migrants, refugees, displaced persons and other marginalised groups in the content of such indicators. The authors’ recommend that communities, civil society and health justice advocates vigorously engage in country's formulation of post-2015 indicators and that the inclusion of non-nationals be anchored in the international human right to health, which in turn requires appropriate financing allocations as well as robust monitoring and evaluation processes that can hold technocratic decision-makers accountable for progress.
Values, Policies and Rights
An international order responsible for widespread inequalities and poverty prevents the realisation of the right to health. The affirmation of health as a human right and the definition of its relation to other human rights are essential to clarify the obligations of those involved in its realisation. This brochure discusses: the right to health and its implementation.
The drive for Universal Health Coverage is currently very intense. Everybody seems to agree on this objective. However, the term is argued to be ambiguous term and in Latin America two different notions
are used. One refers to forms of health insurance, be they voluntary or compulsory and public or private, and in variable combinations. The other refers to a single public health system—ie, a unified tax-funded health system as an obligation of the state. The authors argue that it is critical to distinguish between these two notions and to set uniform criteria of analysis to compare their achievements. In this context, these are: population and medical coverage in their categories of universal or segmented access and use of service and possible barriers; origin and management of health funds; type of providers; health expenditure, public and private; distribution of costs and amount of out-of-pocket expenditure; impact on public health actions and health conditions; and equity, popular participation, and transparency. Taken together, these reveal the extent to which the right to health, a widely held social value, is attained. The authors analyse the largely pluralist health insurance in Latin America and argue that it does not grant the right to health, understood as equal access to the necessary services for equal need. By contrast with the intrinsic restrictions of universal health insurance, the problems of the single public health system are identified as operational. Where implemented in Latin America, while they have problems to resolve, these unified publicly funded systems are argued to be 'on their way to grant the right to health'.
This report aims to show that the humanitarian challenge of the twenty-first century demands a step-change in the quantity of resources devoted to saving lives in emergencies and in the quality and nature of humanitarian response. The report recommends that governments, external funders, the United Nations and humanitarian agencies must ensure that humanitarian needs are properly assessed, and that aid is implemented impartially, while donor governments must increase the volume of humanitarian assistance. Governments, international humanitarian agencies and local civil society must recognise the limitations of providing relief and address the underlying causes of human vulnerability. International humanitarian agencies must work much more consistently to build states' capacity to discharge their responsibilities towards their citizens as well as citizens' capacity to demand that their rights are respected. Governments, acting both bilaterally and through multilateral organisations, also have a clear duty to support other states to realise the right to life and security through exerting diplomatic pressure, as well as by offering financial aid and technical assistance.
The United Nations (UN) has passed two resolutions on the right to water and sanitation. The resolution, ‘The human right to water and Sanitation’, was passed by the General Assembly on 28 July 2010, and the resolution, ‘Human rights and access to safe drinking water and sanitation’ was passed by by the Human Rights Council on 30 September 2010. By framing access to water and sanitation as a human right, these resolutions seek to promote ‘national and international justifiable approaches that promote accountability and transparency and provide mechanisms to progressively realise increasing peoples access to water and sanitation’. However, critics point out that the legal basis for recognising the right to water is not adequately established by the resolutions. According to this article, the primary issue confronting the international community will be translating the resolutions into reality. Proposals by the UN include developing tools/mechanisms to achieve the right to safe water and sanitation, ensuring full transparency in the implementation process of delivering safe drinking water and sanitation, focusing on marginalised groups, adopting/implementing effective regulatory frameworks, and putting in place accountability mechanisms to remedy human rights violations.
This report by the Special Rapporteur on the Right to Food, Olivier de Schutter, examines the contribution of development cooperation and food aid to the realisation of the right to food. Interventions include both long-term support for food security and short-term answers to emergency situations. This report makes a number of suggestions on how to reorient both types interventions by better integrating a perspective grounded in the human right to adequate food at three levels: in the definition of the obligations of donor states; in the identification of the tools on which these policies rely; and in the evaluation of such policies, with a view to their continuous improvement. At its core, a human rights approach turns what has been a bilateral relationship between donor and partner, into a triangular relationship, in which the ultimate beneficiaries of these policies play an active role. Seeing the provision of foreign aid as a means to fulfil the human right to adequate food has concrete implications, which assume that donor and partner governments are duty-bearers, and beneficiaries are rights-holders.
The authors investigated how gender power relations within households affected women’s health outcomes in Simiyu region, Tanzania. Women who reported being able to make their own health decisions were 1.57 times more likely to use condoms. Women who reported that they decide how many children they had also reported high contraception use. Seeking care at the health facility was also associated with women’s autonomy for making major household purchases. The authors observe that the association between decision-making and other gender domains with women’s health outcomes highlights the need for heightened attention to gender dimensions of intervention coverage in maternal health. They suggest that future studies should integrate and analyze gender-sensitive questions within coverage surveys.
This study determined whether laws and regulations in Botswana, South Africa and Zambia – three countries with a high tuberculosis and HIV infection burden – address elements of the World Health Organisation (WHO) policy on tuberculosis infection control. An online desk review of laws and regulations that address six selected elements of the WHO policy on tuberculosis infection control in the three countries was conducted in November 2015 using publicly available domestic legal databases. The six elements covered: (i) national policy and legal framework; (ii) health facility design, construction and use; (iii) tuberculosis disease surveillance among health workers; (iv) patients’ and health workers’ rights; (v) monitoring of infection control measures; and (vi) relevant research. The six elements were found to be adequately addressed in the three countries’ laws and regulations. In all three, tuberculosis case-reporting is required, as is tuberculosis surveillance among health workers. Each country’s legal and regulatory framework also addresses the need to respect individuals’ rights and privacy while safeguarding public health. These laws and regulations create a strong foundation for tuberculosis infection control. Although the legal and regulatory frameworks thoroughly address tuberculosis infection control, their dissemination, implementation and enforcement were not assessed, nor was their impact on public health. The authors argue that future research should assess the implementation and public health impact of these laws and regulations.
This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. The authors conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity. This includes leadership that is gender responsive and institutionalised; development of enabling environments for women's leadership; increasing thought leadership events related to women's role in global health; supporting leadership development, including management training and soft skills and building capacity, including formal training in technical skills, research and mentorship. The authors also call for improved policy and practice in terms of the health and safety risks women face in carrying out their health-related roles.
The 2030 Agenda for Sustainable Development has been agreed, along with 17 Sustainable Development Goals (SDGs) and their 169 targets seek to build on the Millennium Development Goals (MDGs) and “complete what these did not achieve”. MDG4: Reduce Child Mortality is one the goals which failed to achieve its single target to “Reduce by two-thirds, between 1990 and 2015 the under-five mortality rate (U5MR).” MDG4 mobilised global efforts to promote child survival and health, (and indeed between 1990 and 2013, the annual number of under-five deaths declined by half to 6.3 million) but was also critiqued from many diverse perspectives. Despite global progress towards MDG4, the poorest children and indeed the poorest countries, have been left behind. SDG Target 3.2, states: 'By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under five mortality to at least as low as 25 per 1,000 live births'. For SDGs to build on the lessons of the MDGs, the author indicates that the targets should be framed in the unambiguous terms of reducing inequalities. The author suggests that it is difficult to predict how target 3.2 will be measured, and how countries will be held globally accountable, but proposes that all countries should at least report on the gap in child survival between the richest and the poorest, and their progress towards equality of outcomes. To make sure this happens, civil society and human rights mechanisms need to be mobilized around the child’s right to survival and to health, without discrimination.